0:01

We now know that there are additional lesions.

0:04

Let me show you examples of these.

0:07

This is a volar capsular detachment

0:10

where the disc attaches to the capsule,

0:13

and this is what it looks like.

0:14

This taken from the literature showing you the edema

0:17

between the disc and the joint capsule.

0:21

This is a similar lesion,

0:22

this one taken from an exhibit at the RSNA.

0:25

This is a dorsal capsular detachment.

0:29

You can see the edema in this area between the disc

0:33

and the dorsal capsule.

0:35

This is my cadaver.

0:36

It doesn't quite fit the bill,

0:38

but at least we have a lesion close to that region.

0:43

There is another lesion

0:44

that's called a dorsal carpal detachment.

0:47

Here's what it looks like in the coronal plane.

0:50

The, uh, failure right at this triquetral attachment,

0:53

also known as thei kawa lesion.

0:59

There are two types of bucket handle tears.

1:02

One of them shown here is an intradiscal, uh,

1:06

bucket handle tear right in the disc.

1:09

Here's an example of what that might look like.

1:12

The second is more complicated.

1:15

That's taken from a rad source, uh, article or,

1:18

and you can see it's between the disc

1:21

and the radi nerve ligament.

1:22

In this case, the volar radi nerve ligament.

1:25

So here's the tear or separation. Here's the disc.

1:29

Here's the volar radi nerve ligament. Same thing here.

1:33

Here's the tear between the disc

1:35

and the volar radial in their ligament.

1:39

There are two types of flap tears that have been described.

1:44

One of 'em is a distal flap tear shown here,

1:49

where a portion of the TFC is displaced into the pre

1:54

reset, and in this case also

1:57

with the dorsal radial nerve ligament.

1:59

So here's the abnormal tissue. That's the pre recess.

2:04

Here is the abnormal tissue in the pre recess.

2:08

And then the other one, which I have encountered in several

2:11

examples, is proximal displacement

2:16

of a flap of the triangular fibrocartilage.

2:19

So you will see it in the distal radio on the joint, either

2:23

as a linear or as a kind of a oval,

2:28

uh, area of low signal intensity.